State combines databases to cull ineligible spouses from health insurance rolls

The state of Connecticut is connecting information from two online databases to determine whether government employees are keeping ineligible spouses on their health insurance plans. Those spouses could become ineligible for insurance after a divorce or legal separation.

One database lists state employees and retirees who receive state health benefits; the other shows divorce cases in the state. That comparison yielded 223 "hits" involving 138 state employees and 85 retirees, reports the Hartford Courant.

The information has been turned over to the state's Office of Labor Relations, which will contact each of the employees for an explanation. The employee and spouse could have the same names as another couple that divorced, for instance, or the couple recently divorced and the employee simply neglected to remove the spouse from coverage.

It's not clear what will happen if employees are found to have purposefully left the spouse on the rolls, though one possibility is being charged retroactively for premiums, according to the Courant.

"We're just in the 'due diligence' kind of mode right now," Linda Yelmini, the head of the Office of Labor Relations, told the newspaper. "To see whether there is anything amiss."

The computer-assisted audit comes less than a year after disclosures of scores of people, including state employees, who improperly received emergency food stamp benefits after a destructive storm hit the state in August 2011.

A number of factors, including accountable care and payment reform, have focused emphasis on using data improve to quality, cut costs and boost efficiency in healthcare. Though there's lots of talk about using real-time predictive analytics to improve clinical practice, most organizations use data centers for retrospective analysis rather than real-time decision support, according to a recent CHIME survey.

Payers, in particular, have been enhancing their analytical capabilities to combat fraud and abuse, control healthcare costs and ensure premium dollars are appropriately spent.

Meanwhile, two large U.S. companies, Sears and Darden Restaurants, have changed the way they insure employees, offering them fixed amounts of money to buy insurance plans from a health insurance exchange. The plan is designed to drive competition and efficiency among insurers.

To learn more:
- read the Courant story


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